Objective To analyse the clinical features in general paresis of insane(GPI)as to offering an early diagnosis. Methods A retrospective analysis of 2 cases of GPI was focused on their clinical manifestations. Results The clinical features of GPI showed: (1) Chronic onset, progressive development in 2 cases; (2) Dementia was key symptom.Hasegawa dementia scales were 4 and 17 in 2 cases.2 cases accompanied with abnormal mentality,such as delusion of grandeur ,euphoria and so on;(3)GPI have features of pupil change,dysarthria,muscular tension,abnormal reflection; (4) Serum and cerebrospinal fluid (CSF) syphilis antibody reaction manifested positive, CSF protein content was increased significantly, and cells increased ( with lymph cell mainly ); (5) Head MRI manifested: cerebral atrophy in 2 cases, multiple abnormal signals in cerebral parenchyma in 1 case. Conclusions GPI misdiagnosis rate is high. Important basis of diagnosis remains on clinical manifestations, laboratory and imaging examinations.

Objective To study the relationship of expression of angiopoietin gene and angiogenesis in the in-situ implanted hepatoma in rats. Methods Forty Wistar rats were used to establish the in-situ implanted hepatoma model by implanting Walker256 hepatoma cell line. The number of microvessel density(MVD) in hepatoma was calculated . The expression of angiopoietin mRNA was observed by in-situ hybridization method. Results The MDV in the implanted hepatoma in the first day of 1, 2 and 3 week postimplantatively were (15?4.3)/Hp,(17?3.6)/Hp,(45?7.8)/Hp respectively. The amount of MDV and expression of Ang-1 mRNA were increased significantly and correlated with MDV in the hepatoma tissues and non-hepatoma tissues,and no significant difference between the two types of tissues. Expression of Ang-2 mRNA was not seen in non-hepatoma tissues,but in hepatoma tissues,the expression of Ang-2 was obvious. Conclusions Angiopoietin-2 mRNA may play a role in the angiogenesis of the in-situ implanted hepatoma.

Objective To analyze complications of carotid artery stenting (CAS) and preventions.Methods Clinical data and treatment outcomes of 72 consecutive patients ( 80 stents ) from July 2006 to January 2012 with carotid stenosis were analyzed.Asprin 100 mg and clopedigrel 75 mg were given orally 5 days before CAS.Distal embolic protection device were implanted in all patients,pre-dilatation was done for those with carotid stenosis ＞ 90％ and post-dilatation was done for those of residual stenesis ＞ 30％.Severe complications of CAS mean death,myocardial infarction (MI) and stroke.Other minom included transient ischemic attack ( TIA ),hyperperfusion and intracranial hemorrhage ( ICH ),bradycardia and/or hypotension,hypertension,access hematoma or bleeding.Results In 72 patients a total of 80 self-expandable bare stents were successfully implanted.Distal embolic protection devices were used in all cases.Combined procedure was taken in 5 cases including OPCABG in 2 cases,left subclavain artery stenting in 2 cases and renal artery stenting in 1 case.The overall in-hospital complications was 37.5％ (27 of 72).Of these events,1 case had minor strokes defined as a modified Rankin Scale score less than 3 at 1-year follow-up,2 patients (2.78％ ) experienced a hemispheric TIA (neurological symptoms that resolved within 24 hours),1 patient experienced hyperperfusion syndrome.The overall mortality rate was 0,21 cases (29.2％ ) experienced hemodynamic instability (hypotension in 15 cases,bradycardia in 5 cases and hypertension in 1 case) and 2 others had access hematoms.The 30-day death/stroke/myocardial infarction risk was 1.39％ (1 minor stroke).Conclusions Hemedynamic instability (hypotension and bredycardia) is main complications of carotid artery stenting in patients with carotid artery stenosis,severe complications are rare.

Objective To investigate effect of sorafenib on serum hepatoma marker in patients with advanced hepatocellular carcinoma. Methods 101 patients with advanced hepatocellular carcinoma were selected, and divided into two groups.50 cases in control group were treated with routine clinical treatment, and 51 cases in experimental group were treated with sorafenib on the basis of control group.The survival time, adverse reactions, VEGF, CTGF, HIF-1 and OPN levels were compared after the treatment.Results The survival time of experimental group was higher than control group (P<0.05).Compared with control group, the serum levels of VEGF、CTGF,HIF-1, OPN,AFP, CEA, and CA199 in experiment group were lower (P<0.05,P <0.01).There were no significant differences of total adverse reactions between experimental group and control group. Conclusion Sorafenib can effectively prolong survival time of patients with advanced hepatocellular carcinoma, reduce serum VEGF, CTGF, HIF-1 alpha and OPN levels.

Objective To evaluate carotid endarterectomy (CEA) for bilateral moderate to severe carotid stenosis.Methods The clinical data of 59 patients with bilateral moderate to severe carotid stenosis who were treated with CEA in our hospital from October 2010 to August 2014 were retrospectively analyzed.There were 50 males and 9 females age ranging 42-80 years (mean:65 ± 9 years).48 patientsunderwent ipsilateral CEA and 11 underwent staged bilateral CEA.In patients who were confirmed to have coronary artery disease or peripheral vascular disease by preoperative angiography,6 received coronary artery bypass graft (CABG)simultaneously,1 received iliac artery balloon angioplasty and stent implantation simultaneously,and 1 received renal artery stenting simultaneously.Results A total of 70 endarterectomies were performed,shunt and patching were used in all patients,the surgical success rate was 100％.2 patients suffered from vagus nerve injury,4 patients suffered from hypoglossal nerve injury,and 3 patients presented with hyperperfusion syndrome.Follow-up period was 2-36 months (mean:19 ± 10 months).1 patient died of heart attack during the follow-up,the other patients were relatively stable with no restenosis.Conclusion CEA should be performed in patients with bilateral moderate to severe carotid stenosis,and the prognosis is good.

Objective To investigate the effects of long-term glucocorticoid administration on neuromuscular block of cisatracurium in elderly patients undergoing general anesthesia. Methods Forty ASA Ⅱ or Ⅲ patients,aged≥65 yr,with BMI of 18-24 kg/m2 ,scheduled for elec-tive operation were studied.According to the history of using or not long-term glucocorticoid,patients were assigned into two groups (n = 20 each):control group(group C),glucocorticoid group(group J).Midazolam 0.03 mg/kg was injected,mask inhalation of 8% sevoflurane and flow rate of oxygen 8L,every 30 s decline 2%,until the 4%.After the disappearance of eyelash reflex,cisatracurium 0.1 5 mg/kg was injected intravenously.After 1 min intravenous injection of remifentanil 2 g/kg and 30 s after stop of sevoflurane inhalation anesthesia, endotracheal intubation for mechanical ventilation,target controlled infusion of propofol and remifentanil anesthesia,using TOF-Watch SX acceleromyography monitoring of muscle relaxation,and onset time,clinical duration and recovery in-dex(for T1 to return from 25% to 75% of the control twitch)were recorded.Results Compared with group C,the onset time was significantly prolonged,clinical duration and recovery index were short-ened in group J (P <0.05 ).Conclusion Long-term glucocorticoid admininstration could reduce the neuromuscular blocking effect of cisatracurium in elderly patients.

Objective To evaluate the effects of long?term glucocorticoid administration on cisatra?curium?induced neuromuscular blockade in the patients undergoing laparoscopic operation. Methods Six?ty?four patients of both sexes, aged 40-64 yr, with body mass index of 18-22 kg∕m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic operation under general anesthesia, were assigned into 4 groups ( n=16 each) according to whether or not glucocorticoid was used for a long?term period: control ( non?hormone and non?laparoscopic operation ) group ( group C ) , hor?mone + laparoscopic operation group ( group HL ) , non?hormone + laparoscopic operation group ( group NHL) and hormone +non?laparoscopic operation group ( group HNL) . Midazolam 0.03 mg∕kg was injected intravenously, 8% sevoflurane was inhaled by mask, and the concentration of sevoflurane was decreased by 2% every 30 s until the concentration of 4% was reached. After loss of eyelash reflex, remifentanil 2μg∕kg was injected intravenously over 1 min, and 30 s later sevoflurane inhalation was stopped. The patients were tracheally intubated and mechanically ventilated. Anesthesia was maintained with propofol and remifentanil given by target?controlled infusion. Neuromuscular blockade was monitored with accelerograph TOF?watch
SX. At 20 min of pneumoperitoneum in NHL and HL groups or 20 min after intubation in C and HNL groups, cisatracurium 0. 15 mg∕kg was injected intravenously. The onset time, maximal degree of N?M block, clinical duration and recovery index of cisatracurium were recorded. Results Compared with group C, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clini?cal duration was shortened, and the recovery index was decreased in HL and HNL groups ( P<0.05) , and the clinical duration was significantly prolonged, the recovery index was increased ( P<0.05) , and no sig?nificant change was found in the onset time in group NHL ( P>0.05) . Compared with group HNL, the clin?ical duration was significantly prolonged, the recovery index was increased (P<0.05), and no significant change was found in the onset time in group HL ( P>0.05) , and the onset time was significantly shortened, the clinical duration was prolonged, and the recovery index was increased in group NHL ( P<0.05) . Com?pared with group NHL, the onset time was significantly prolonged, the maximal degree of N?M block was decreased, the clinical duration was shortened, and the recovery index was decreased in group HL ( P<0.05) . Conclusion Long?term glucocorticoid administration can weaken cisatracurium?induced neuromus?cular blockade in the patients undergoing laparoscopic operation.

The clinical data of 21 patients with carotid body tumor (CBT) were analyzed retrospectively.The lesions were unilateral (n =20) and bilateral (n =1).Among 20 surgical cases, the procedures included tumor resection alone (n =11) , tumor resection along with external carotid artery (n =6) and vascular reconstruction of carotid artery after resection of tumor body (n =3).No mortality occurred during perioperative period.CBT was confirmed by pathologic examination in all cases and 1 case was malignant.Follow-up period ranged from 3 months to 7 years and the follow-up rate was 85％.Five cases of cranial nerve impairment recovered completely over 3 months.One case of bilateral CBT underwent contralateral tumor resection at another hospital 1 year later and 1 case with malignant tumor died from metastases 3 years later.The remainder survived recurrence-free.CBT tends to be misdiagnosed.Therefore ultrasonography, digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance angiography (MRA) are important for preoperative diagnosis and evaluation.Surgical resection is a first choice for CBT.

Objective To study the clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis.Methods The clinical data of 36 patients with 1-year follow-up who had a wrist ulnar-basilic arteriovenous fistula formed in China-Japan Friendship Hospital from January 2013 and December 2014 were retrospectively analyzed.The outcomes for this study including the surgical results,complication rate of ulnar-basilic arteriovenous fistula,immediate patency rate,average maturation time,1-year primary patency rate and true patency rate were analyzed.Results Thirty-four cases patients got successful ulnar-basilic arteriovenous fistula formed with palpable vascular thrill.There were no death cases and no severe cardio-cerebrovascular complications.No infection,heart failure,distal swelling and ischemia occurred.The immediate patency of ulnar-basilic arteriovenous fistula was 94.4%(34/36),the average maturation time was (67±4) d,1-year primary patency rate was 63.9%(23/36),and true patency rate was 67.6%(24/36).Conclusion Ulnar-basilic arteriovenous fistula with adequate 1-year primary patency and low risk of infection and complications can be a viable alternative as the hemodialysis vascular access.

Objective To identify the risk factors for early postoperative cognitive dysfunction (POCD) in the elderly patients undergoing spinal surgery.Methods One hundred and fifty ASA Ⅱ or Ⅲ patients,aged ≥65 yr,undergoing elective spinal surgery under general anesthesia,were studied.Venous blood samples were taken at 1 day before operation and 7 days after operation to determine the concentration of serum S-100B protein.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation and 7 days after operation.The patients were diagnosed as having POCD if MMSEpre-MMSEpost ≥ 3.The patients were divided into POCD group and non-POCD group.Age,body weight,sex,education,type of operations,complications,preoperative TCM syndrome type,MMSE score at 1 day before operation and 7 days after operation,duration of operation,emergence time,and intraoperative blood loss,cardiovascular events,and amount of fluid infused per hour were recorded.The risk factors for POCD were analyzed using multivariate logistic regression analysis.Results Thirty-eight patients developed early POCD (25.3％).The resuhs of logistic regression analysis showed that age ≥ 70 yr,elementary education or below,duration of operation ≥5 b,and the number of hypotension occurred during operation≥3 were the risk factors for early POCD.Conclusion Age≥70 yr,elementary education or below,duration of operation ≥ 5 h,and the number of hypotension occurred during operation ≥ 3 are the risk factors for early POCD in the elderly patients undergoing spinal surgery.